Wound Suturing, Gluing, and Bandaging, by David in Israel

Having suture equipment even if you don’t have the skills to use it is useful since you can hopefully find a veterinarian, doctor, nurse, PA, or Dentist qualified to use them. Having your own sterile medical equipment for the medical professionals you find is still a common bit of advice for people planning to visit third world countries.

If there is an injury requiring suture and you are not qualified especially in the highly enervated regions where suture can cause serious nerve damage and local paralysis of the body such as the hands and face there is a better way to use steri-strips and butterfly bandages.

Super-Glue related adhesives made of newer 2-octyl-cyanoacrylate instead of the skin irritant traditional Super-glue or cyanoacrylate (that have been in use in surgery and wound management since the 1970s). Qualified health care providers can provide treatment using surgical adhesives like Dermabond as a substitute for suture in many cases. I understand that the FDA in the United States may now allow these safe adhesives to be sold under several names over the counter, if not then Vetabond is a safe alternative.

Any cyanoacrylate related adhesive is reasonably safe to be used topically on the outer surface of the skin to help anchor your butterfly bandages in cases where suture or direct bonding of a wound is impossible because of training or supply issues.

-Use sterile technique at all times, if possible use autoclaved or pressure cooker steamed surgical tools instead of gloved hands just as with sutures
-Observe standard precautions when dealing with blood borne pathogens including eye protection for the care provider
-Clean the wound with antiseptic and remove any foreign debris, iodine based antiseptics are preferred, excellent lighting and visibility is required
-Use alcohol and sterile swabs to remove skin oils from the area to improve bandage adhesion
-consider irrigating or injected epinephrine or epi-lidocaine mix to reduce blood flow and anesthetize the area if you are trained in their safe use
-Close the wound
-Once the edges are aligned apply butterfly bandages
-Glue around the edges of the sticky pads of the butterfly bandage, do not allow adhesive into the wound
-If there is no allergy lightly apply triple antibiotic ointment over wound
-Apply sterile gauze over site
-Assess perfusion and neurologicals below the site
-Change dressing regularly, every few hours at first
-Reassess for infection, perfusion, and neuros after every bandage change
-If there is a question or problem a qualified medical provide should be sought immediately

If there is sign of infection you might need to open, drain, and irrigate the wound. You should seek qualified assistance and antibiotics at this point.

In some cases athletic tape stuck to a larger area of surrounding skin over your gauze dressing may be required to keep the edges of the wound held together. Regular dressing changes are still required.

You must never use circumferential taping (tape which is connected around the circumference of a limb) for any reason as it can act as a tourniquet cutting off blood supply and potentially damaging the limb to the point of requiring amputation especially if there is swelling or bad circulation.

If you have run out of sterile gauze clean white T-shirt material which has been steamed in a pressure cooker works well, only use when dry.

In a world without access to antibiotics an infected wound is one of the leading causes of untimely death so use sterile technique, equipment and supplies. Treat early and aggressively to prevent amputation or mortality.

Shalom, – David in Israel